Ankle Evaluation

1. How did it happen? (etiology)

2. Previous history of injury to that area?

3. Sight evaluation

a) swelling?

b) deformities?

c) discoloration?

4. Palpation evaluation

a) check ligaments

(1) medial: deltoid / anterior, medial, and posterior portions

(2) lateral: Anterior talo-fib

Anterior drawer tests should always be performed with the knee bent to eliminate the Achilles and Gastrocnemius muscles from providing any stability to the ankle. A lateral talar tilt test can be conducted at the same time.

Talar Tilt	Inversion Stress
	Normal Lateral Stress Test, no talar tilt is noted.
Notice the talar tilt. This is a positive lateral stress test.

Achilles Tendon (Thompson Test), with the patient prone, gently squeeze the gastroc-soleus to see if the foot moves into plantar flexion. No movement is considered a positive test for an Achilles tendon rupture.

5. Stress tests

a) check ROM - active: the athlete moves ankle dorsiflexion, plantar flexion, inversion, and eversion.

b) check strength - resistive: check 4 areas

6. Possible fracture tests (Ottawa - Buffalo Ankle Guidelines)

a) bump test - check fracture of talus

Ottawa - Buffalo Modification for Ankle Exam

The incidence of ankle fractures in athletes involved in controlled sports activities is relatively low. However, the decision(s) on which ankles to study radiographically with x-rays is not always easy. Not all ankle or foot injuries require immediate x-rays. The allied health practitioner can determine to a relatively accurate degree the need for further study through a good clinical exam and by following the Ottawa Ankle Rules and with the use of the Buffalo Modification. (for more information, consult the AJSM, Vol 26, No 2. 1998)

Research has shown that in a hospital based E.R. of every 6 ankles approved for x-ray under the O.A.R. (Ottawa Ankle Rules), 5 have no radiographic findings. Steill, I.G., JAMA, 269:1127-1132, 1993.

• Clinical ankle exam

If the patient needs x-rays, they will usually present with lateral fibular malleolus pain in the distal 6 cm, medial tibial malleolus pain in the distal 6 cm or pain to palpation over the proximal tip of the 5th metatarsal or the Navicular.

The inability to bear weight may indicate a lesion to the dome of the Talus or other associated trauma to the other structures of the ankle which may require x-ray study.

Distal 6 cm of either the medial or lateral malleolus		5th Metatarsal or Navicular pain

This inversion ankle sprain is most impressive looking with a great deal of ecchymosis, the clinical findings did not fit with the Ottawa - Buffalo guidelines. Radiographic examination was done due to the amount of swelling and ecchymosis however, as suspected per the O-B guidelines, the X-Rays of this ankle were negative for any fractures.

b) squeeze test - check malleolus (2)

Check tibia and fibula

7. Functional tests

a) walking - check gait

b) toe raises

1) both feet

2) one foot

c) jump and land on both feet and then on one foot

8. Refer to doctor for further evaluation and possible x-ray

Non weight bearing x-rays

Weight bearing x-rays (syndesmosis spreading)

3) Stress x-rays for talar tilt and syndesmosis spreading

9. Other associated ankle and lower leg tests

Homan's Sign - patient is supine on the table, the knee is fully extended and the foot is dorsi flexed. Reproduction of pain with localized edema is considered a positive test for deep venous thrombophlebitis.